Provider Demographics
NPI:1518584606
Name:NETTLES, CAROLINE WITT (NP-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:WITT
Last Name:NETTLES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 NW AMERICAN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-8841
Mailing Address - Country:US
Mailing Address - Phone:386-758-6141
Mailing Address - Fax:386-758-6140
Practice Address - Street 1:228 NW RANCH CT
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8922
Practice Address - Country:US
Practice Address - Phone:386-288-3648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1100691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner